Speech sound disorders …

Hope Dickinson MS CCC-SLP

General Child Neurology

Updated 01.21.2026
Released 06.25.2004
Expires For CME 01.21.2029

Speech sound disorders

Author: Hope Dickinson MS CCC-SLP

See Contributor Disclosures

Editor: Alcy R Torres MD FAAP

Cite this article

Speech sound disorders

In This Article

Quick Link

Introduction

Overview

Speech sound disorder is a broad term that encompasses a number of diagnoses related to speech production difficulties in children. Speech sound disorders are evaluated and treated by speech-language pathologists. Awareness of these disorders aids physicians in effective and timely referrals. This article reviews common childhood speech sound disorders, includes a current understanding of genetic underpinnings, touches on nondevelopmental and degenerative causes of speech disorders, and provides an overview of current assessment and intervention approaches.

Key points

	• Across languages, speech sounds emerge in a predictable fashion during the development of young children, with a complete speech sound inventory present by early school age.
	• Speech sound disorders are the most common communication disability in young children and manifest in the form of incorrect pronunciation, particularly of consonants. They differ in etiology, severity, and outcome.
	• Many common childhood speech disorders have unknown etiologies. However, some are associated with genetics and developmental disabilities. Others have anatomic and neurologic causes. In adults, speech sound disorders may result from neurologic insults or degenerative diseases that affect speech production muscles.
	• Even when speech errors are resolved, associated language and literacy difficulties may persist.
	• Treatment of speech sound disorders varies depending on a number of factors, including etiology, type, and severity. Determining evidence-based practices is an active area of research.

Historical note and terminology

Demosthenes, the Greek orator, was said to have sought improved speech production in his youth by placing pebbles underneath his tongue, reciting verses while running, and shouting above the sound of the ocean. Aristotle recognized that the organized combination of consonants and vowels is required for human speech. French physician Jean-Baptiste Bouillaud listed the components required for spoken language as the instruments, such as the tongue, which provide “articulatory power,” and the “cerebral organ,” which coordinates speech. In 18th century Britain, James Fords advertised his services for “stammering and other speech” problems. In the United States, the American Academy of Speech Correction was founded in 1925. The organization was later retitled the American Speech-Language-Hearing Association (ASHA), a name that remains today.

The term “speech sound disorder” as defined by the International Expert Panel on Multilingual Children’s Speech includes “any combination of difficulties with perception, articulation/motor production or phonological representation of speech segments (consonants and vowels), phonotactics (syllable and word shapes), and prosody (lexical and grammatical tones, rhythm, stress, and intonation) that may impact speech intelligibility and acceptability” (International Expert Panel on Multilingual Children’s Speech). Therefore, speech sound disorders can refer to difficulty with articulation, phonology, or motor speech.

The term “phonological disorder” is sometimes used interchangeably with “articulation disorder.” However, the American Speech-Language-Hearing Association distinguishes phonological disorder as the confusion of certain patterns or classes of sounds. Articulation disorder relates to the inability to produce certain sounds, emphasizing the motor act of speech production. Dysarthria is a neuromotor disorder that results from abnormalities in the speed, strength, accuracy, range, tone, or duration required for speech control (20). Childhood apraxia of speech is defined as “a neurologic childhood (pediatric) speech sound disorder in which precision and consistency of movements underlying speech are impaired in the absence of neuromuscular deficits” (02).

Clinical manifestations

Presentation and course

Speech sound disorders manifest with impaired intelligibility in the form of incorrect pronunciation, particularly of consonants. Most toddlers and preschool children make predictable speech errors that are not considered disordered but rather part of normal development. Across languages, children accurately produce most consonant sounds by 5 or 6 years of age (31). Most speech sound disorders can therefore be identified and begin to be addressed by preschool to early school age. Children whose speech includes atypical errors and severely reduced intelligibility are often identified earlier. Conversely, identification of speech sound disorders may be delayed in children with coexisting language impairment who begin to speak later than average. In English, the most problematic consonants are the later-acquired “r,” “s,” and “th,” although individual variation is to be expected. In articulation and phonological disorders, sound errors tend to be consistent, whereas inconsistent productions and rate disturbances occur more frequently in motor speech impairments.

General guidelines for the intelligibility of multiword utterances, based on data for the lowest performing typical children, are as follows: (a) by 4 years, children’s speech should be at least 50% intelligible to an unfamiliar listener; (b) by 5 years, speech should be at least 75% intelligible to an unfamiliar listener; and (c) by just over 7 years, speech should be 90% intelligible to an unfamiliar listener (17).

Prognosis and complications

Children with preschool histories of speech sound disorders have differing trajectories and variable long-term outcomes in speech, language, and academic skills. Risks for ongoing impairment in these areas include comorbid language impairment, persistent speech disorder, poor phonological awareness skills, lower nonverbal cognitive abilities, motor impairment, and social disadvantage (27; 58). Residual or persistent speech errors are estimated to occur in 1% to 2% of older children and adults (15), with the strongest predictor of ongoing speech impairment being poor early phonological skills (05). People with persistent speech sound disorders show deficits in phonology and phonological awareness, albeit increasingly subtle with age (43). In one group of 125 children aged 3 to 6 years with speech disorders, no relationship between early reading and writing scores and severity of the speech disorder was found once comorbid language impairments were considered (49). Nevertheless, children with dyslexia generally have more difficulty with speech production tasks, suggesting there is an association between dyslexia and underlying phonological awareness (56).

Clinical vignette

KD was a 3-year-old boy with no significant medical history, a normal neurologic exam, normal hearing sensitivity, and speech sound problems. He spoke in short phrases that were mostly unintelligible due to consonant omissions and substitutions and vowel distortions. His parents described his speech as inconsistent and choppy. KD’s struggles to communicate were frustrating for him and his family and were affecting his relationships with peers.

A speech-language evaluation resulted in a diagnosis of childhood apraxia of speech and concomitant expressive language disorder. Intensive therapy was initiated, with repetitive practice in motor planning, programming, and production that targeted movement between sounds and prosody. Multisensory input and choral speaking were used to support speech improvement. Language goals, especially for expressive grammar, and phonological awareness skills, were incorporated in later stages of therapy. The path to improved speech production and intelligibility was long and gradual, but KD’s communicative frustration decreased and successful communication improved over time. He continues to be monitored for language and literacy development.

Biological basis

Etiology and pathogenesis

The term “articulation” implies moving surfaces from opposing positions into positions that come into contact. Articulators, such as the lips, teeth, tongue, palate, and jaw shape and direct the flow of air from the larynx into speech sounds. However, difficulties with speech intelligibility often localize poorly because speech production can be affected by lack of accurate feedback (hearing impairment), deficits in cognition, breath support, phonation, and articulation. Production of speech sounds can be disrupted at multiple levels: cerebral cortex, basal ganglia, cerebellum, cranial nerves (V, VII, IX-X, and XII), peripheral nerves, neuromuscular junction, and the structural apparatus of the lips, palate, tongue, velopharynx, and vocal folds.

Speech sound disorders in children have sometimes been seen as either purely structural or idiopathic. However, genetic components are increasingly being recognized. It is well documented that genetic factors contribute to susceptibility to speech and language impairments. Speech and language deficits are heritable and show strong familial aggregation (03; 08; 10; 26). Speech sound disorders have been linked to the 15q14 locus (50) and FOXP2 deletions on chromosome 7 (24; 53). However, these regions have also been implicated in more global language disabilities and other neurodevelopmental disorders. More recent research findings suggest that about one third of children with childhood apraxia of speech have a genetic variant that explains the diagnosis, with significant genetic heterogeneity emerging (33).

Motor difficulties in cerebral palsy can cause speech difficulties that persist into adulthood. A 2016 study of 42 adults with cerebral palsy found that most had moderate to severe dysarthria with symptoms across speech dimensions (46). Minor neuromotor abnormalities, associated with many developmental disabilities, may manifest with low oral tone and can contribute to articulatory difficulties in such neurodevelopmental disabilities as ADHD, learning disorders, and epilepsy. In a small case-control study, children with epilepsy without intellectual disability or cerebral palsy had more articulation difficulties than typically developing children (47). In addition, cognitive impairment may contribute to articulation problems, probably due to mislearning of speech sounds. For some children, there are multiple factors that contribute to speech production deficits. For example, Down syndrome affects speech production at numerous levels, including intellectual disability, a smaller oral cavity, and tongue-to-mouth ratio, hypotonia, and possible hearing loss (21).

Other syndromes and differences that affect the motor anatomy necessary for speech can result in speech sound disorders. For example, Moebius syndrome involves congenital paralysis of bilateral facial and abducens nerves and can result in speech sound difficulties. Cleft palate may affect speech through anatomic differences prior to repair, persistent velopharyngeal insufficiency, habituation of learned speech errors, as well as coexisting factors, such as dental and occlusal anomalies, middle ear effusion, and conductive hearing loss (22).

Both conductive and sensorineural hearing loss can independently affect speech by distorting or degrading the speech signal and impairing discrimination of speech sounds and auditory feedback, which can hinder correct learning and reproduction of speech sounds. Children with recurrent otitis media often experience fluctuating hearing loss and may benefit from myringotomy and ear tube surgery. Cochlear implants are a prevalent treatment for children with severe to profound sensorineural hearing loss. The minimum age for implantation recommended by the U.S. Food and Drug Administration is 9 to 12 months, with the recommendation for language exposure through sign language until implantation. A 2024 study demonstrated that cochlear implantation conducted before the age of 3 and continued use of cochlear implants over an extended period have beneficial impacts on the development of phonological skills (23). Important factors in outcomes are age at implant, duration of implant use, gender, language skills, and maternal education.

Differential diagnosis

Children typically learn to pronounce consonants in an orderly sequence. Although a speech sound disorder cannot be diagnosed solely by the absence of one or more speech sounds at a particular age, it is important to know expected ages of acquisition, as certain sounds are mastered later, even in typical development (31).

Table 1. Speech Milestones in Young Children

The average ages at which children learn to pronounce English consonants correctly are as follows (31):

Age	Speech sound
2 to 3 years	p, b, m, d, n, h, t, k, g, w, ng, f, y
4 years	l, j, ch, s, v, sh, z
5 years	r, sh, th (voiced)
6 years	th (voiceless)

When there is concern for a speech sound disorder, one should look for any underlying causes and rule out acquired disorders before concluding there is an idiopathic speech sound disorder. Both conductive and sensorineural hearing loss can lead to mislearning certain speech sounds and should be evaluated. Atopy, including allergic rhinitis and eczema, may affect articulation, possibly via transient hearing loss (52). Children with expressive language disorders may present as difficult to understand due to problems in language structure. Stuttering affects fluency rather than articulation. Acquired epileptic aphasia (Landau-Kleffner syndrome) causes acute-onset speech-language problems and seizures. Variations in pronunciation attributable to dialect or learning English as a second language do not constitute speech sound disorders.

Acquired speech sound disorders include apraxia and the dysarthrias. Causes of these acquired impairments include neurologic injuries, such as stroke, traumatic brain injury, tumor and its resection, and neurodegenerative disorders affecting the motor system, such as Parkinson disease and amyotrophic lateral sclerosis (35; 13). Isolated dysarthria or posterior fossa syndrome following surgical resection of posterior fossa tumors is not uncommon (34). Finally, chemoradiation can also affect articulation in patients with head and neck cancer (19). The dysarthrias involve paralysis, weakness, or incoordination of speech musculature (55). Dysarthrias are generally classified as flaccid, spastic, hypokinetic, hyperkinetic, ataxic, and mixed. There is a range of clinical presentations; however, the dysarthrias usually share imprecise articulation, prosodic disturbance, reduced variation in loudness, and voice differences, including breathy or harsh voice (11; 12). Acquired apraxia of speech is characterized by phoneme distortions, substitutions, or additions, reduced speaking rate, syllable segregation, and equal stress related to deficits in planning and programming movements for speech. Acquired apraxia of speech can improve, remain stable, or worsen depending on specific diagnosis and time elapsed since onset (ASHA Practice Portal).

Confusing conditions

Regarding terminology, “speech” and “language” are not interchangeable labels. Language relates to a message’s content, including vocabulary, grammar, and sentence structure. Speech, on the other hand, relates specifically to sound production. Children with language disorders and speech disorders present differently, though the disorders often co-occur.

Diagnostic workup

Although outward characteristics of speech sound disorders may overlap, determining the specific subtype of speech sound disorder is vital for a number of reasons, including prognosis and determining a treatment approach. Referral to a speech-language pathologist is the most effective way to define speech sound disorders.

The speech-language pathologist gathers a complete history, including any prenatal and neonatal complications, hearing and middle ear problems, and infant feeding difficulties. Audiologic evaluation is needed in any child with speech production challenges, even in the absence of middle ear pathology. Evaluation of structural defects, such as cleft palate or dental malocclusion, is needed. Palatal and laryngeal concerns should be evaluated by an otolaryngologist. If there are concerns with aspiration, a swallow study should be considered. It is important to identify cognitive impairment and dysmorphisms suggestive of genetic syndromes and to look for any additional neurologic signs that would suggest a broader disability. Spasticity, dystonia, or flaccidity should be noted. Cerebellar signs, such as gait ataxia or dysdiadochokinesia, may aid in localization. Consider magnetic resonance imaging of the brain and spine in cerebral palsy, where underlying etiology may be defined. Genetic testing is becoming more common in children with speech sound disorders given the increasing awareness of genetic causes.

Speech language pathologists use analysis of spontaneous speech and commercially available tests, such as the Goldman-Fristoe Test of Articulation 3 and the Diagnostic Evaluation of Articulation and Phonology. Many oral language batteries also include an articulation screening component. Other diagnostic techniques include repetition of multisyllabic words and nonwords, sentence repetition, and diadochokinetic tasks. Speech language pathologists transcribe the child’s speech using the International Phonetic Alphabet (IPA) to tally and classify type, frequency, and consistency of speech production errors. A detailed oral and speech mechanism exam identifies anatomical or functional problems. Dynamic assessment or stimulability testing provides important information regarding the potential “learnability” of speech sounds and helps in treatment planning. In addition to specific articulation testing, it is important to measure intelligibility of single words and continuous speech to determine the functional severity of a speech disorder (29).

Management

Once structural and sensory/perceptual deficits have been addressed or ruled out, speech therapy is the major treatment for speech sound disorders. Determining a treatment approach relates to type, etiology, and severity of the speech disorder as well as the presence of any concomitant language, cognitive, or behavioral disorders. Decisions regarding frequency and intensity of intervention are also individually based. Accurate diagnosis of the type of speech sound disorder is therefore imperative in therapy decision-making.

A small intervention study of 14 children with phonological disorders found that although both groups improved in production of speech sounds, only the group with phonological intervention showed improvement in intelligibility (29). In younger or more developmentally challenged children, therapy may shape speech while primarily focusing on language and communication development (54). Some therapies emphasize starting with production of isolated phonemes and building to connected language. Others target mastery of more complex sounds first, which promotes the emergence of less complex ones (16; 51). Children with motor speech disorders, especially childhood apraxia of speech, generally require intensive and lengthy treatment using the principles of motor speech, including a focus on movement between sounds, prosody, multisensory input, and specific and direct feedback (30). Biofeedback technologies, such as ultrasound, are now sometimes used in speech therapy with disorders including childhood apraxia of speech (42).

A systematic review of screening and treatment for speech and language delays found that most treatment resulted in improvement, with characteristics of effective studies, including higher intensity of treatment, more severely affected children, and individualized treatment (04). However, a Cochrane review found no randomized controlled trials or group studies for efficacy of speech therapy for children with dysarthria under 3 years of age (39). In children with cleft palate, speech therapy is indicated alongside cleft palate repair to support intelligibility at their earliest stages of development. One study of 51 children aged 3 or 5 with repaired cleft palate suggested that such children can approximate typically developing children by 5 years of age (07). Another study of 180 children with very late cleft palate repair between ages 3 and 7 found that age at the time of palatal repair was significantly associated with compensatory misarticulations, which further supports earlier intervention (44).

Good speech production requires extreme precision; however, significant strength is not needed. Unfortunately, nonspeech oral motor exercises for “mouth strengthening” are sometimes recommended and conducted in an attempt to influence speech, despite the fact that data for their efficacy are controversial at best (09; 36). An updated Cochrane review confirmed previous conclusions that there is no strong evidence that suggests nonspeech oral motor therapy is effective for developmental phonological disorders. The three studies they found evaluating efficacy of nonspeech oral motor therapy were small in scale and had a number of serious methodological limitations (25).

Concern about the possible effect of tethered oral tissues, such as ankyloglossia, on speech production has significantly increased in the last several decades. However, a 2013 systematic review found no causal relationship between tongue-tie and speech production (57). In 2020, Salt and colleagues also found no significant difference in speech production, parent/clinician speech intelligibility ratings, and tongue mobility between groups of young children with treated tongue-tie, untreated tongue-tie, and no tongue-tie (45).

There is a gap in the literature regarding efficacy of speech therapy for speech disorders related to cerebral palsy (48). However, a study of 77 children with cerebral palsy suggested that speech characteristics identified at 2 years of age could predict communication and speech performance at 5 years (38). There is usually impairment at multiple levels of speech production in children with cerebral palsy (32). Therefore, early intervention with a speech language pathologist may be recommended based on individual assessment.

In cases of significant speech intelligibility impairment, augmentative communication support, including picture boards and voice output devices, should be recommended (60; 59).

Outcomes

Outcomes for young children with speech sound disorders vary but are usually good when high-quality intervention is provided early. Severity of the speech disorder, concomitant developmental and medical disorders, cognition, attention, family history, and age at initiation of intervention all contribute to long-term outcomes.

Even if identified and treated early on, speech sound disorders do place children at risk for language and literacy deficits (14). Researchers have agreed that children with speech disorders struggle to acquire phonological processing skills that are closely linked to later literacy outcomes, such as sound segmenting, rapid naming, phonological memory, and rhyming (06). A systematic review assessed 13 articles on preschool speech disorder and impact on literacy skills in middle childhood or adolescence (37). Results indicated that children with speech disorders in early childhood had poorer early literacy and literacy skills compared to typical children, even when the speech disorder was mild. A longitudinal 25-year study on 32 individuals with childhood apraxia of speech reported highly variable outcomes that were associated with early motor difficulties. Difficulties with production of later-developing speech sounds and multisyllabic words, phonological processing, and literacy were often present in the cohort (28). These findings underscore the importance of early identification and intervention for children with speech problems.

References

01: American Speech-Language-Hearing Association. Acquired apraxia of speech. Available at: www.asha.org/practice-portal/clinical-topics/acquired-apraxia-of-speech/. Accessed December 2025a.
02: American Speech-Language-Hearing Association. Childhood apraxia of speech. Available at: www.asha.org/policy. Accessed December 2025b.
03: Barry JG, Yasin I, Bishop DVM. Heritable risk factors associated with language impairments. Genes Brain Behav 2007;6:66-76. PMID 17233642
04: Berkman ND, Wallace I, Watson L, et al. Screening for speech and language delays and disorders in children age 5 years or younger: a systematic review for the U.S. preventive services task force [Internet]. Rockville (MD): Agency for Healthcare Research and Quality, 2015.
05: Bernhardt B, Major E. Speech, language, and literacy skills 3 years later: a follow-up study of early phonological and metaphonological intervention. Int J Lang Comm Dis 2005;40(1):1-27. PMID 15832523
06: Canales WE, McElroy-Bratcher A. The effects of speech sound disorders on literacy outcomes of school-age children. Am J Ed Research 2015;3(10):1290-8.
07: Chacon A, Parkin M, Broome K, Purcell A. Australian children with cleft palate achieve age-appropriate speech by 5 years of age. Int J Pediatr Otorhinolaryngol 2017;103:93-102. PMID 29224774
08: Clark A, O'Hare A, Watson J, et al. Severe receptive language disorder in childhood—familial aspects and long-term outcomes: results from a Scottish study. Arch Dis Child 2007;92(7):614-9. PMID 17405857
09: Clark HM. The role of strength training in speech sound disorders. Semin Speech Lang 2008;29(4):276-83. PMID 19058114
10: Conti-Ramsden G, Falcaro M, Simkin Z, Pickles A. Familial loading in specific language impairment: patterns of differences across proband characteristics, gender and relative type. Genes Brain Behav 2007;6:216-28. PMID 16827920
11: Darley FL, Aronson AE, Brown JR. Differential diagnostic patterns of dysarthria. J Speech Hear Res 1969a;12(2):246-69. PMID 5808852
12: Darley FL, Aronson AE, Brown JR. Clusters of deviant speech dimensions in the dysarthrias. J Speech Hear Res 1969b;12(3):462-96. PMID 5811846
13: Enderby P. Disorders of communication: dysarthria. Handb Clin Neurol 2013;110:273-81. PMID 23312647
14: Farquharson K. After dismissal: examining the language, literacy, and cognitive skills of children with remediated speech sound disorders. Perspectives on School-Based Issues 2015;16(2):50-9.**
15: Flipsen P Jr. Emergence and prevalence of persistent and residual speech errors. Semin Speech Lang 2015;36(4):217-23. PMID 26458197
16: Gierut JA. Treatment efficacy: functional phonological disorders in children. J Speech Lang Hear Res 1998;41(1):S85-100. PMID 9493748
17: Hustad KC, Mahr TJ, Natzke P, Rathouz PJ. Speech development between 30 and 119 months in typical children I: intelligibility growth curves for single-word and multiword productions. J Speech Lang Hear Res 2021;64(10):3707-19. PMID 34491793
18: International Expert Panel on Multilingual Children’s Speech. Multilingual children with speech sound disorders: Position paper. 2012
19: Jacobi I, van Rossum MA, van der Molen L, Hilgers FJ, van den Brekel MW. Acoustic analysis of changes in articulation proficiency in patients with advanced head and neck cancer treated with chemoradiotherapy. Ann Otol Rhinol Laryngol 2013;122(12):754-62. PMID 24592578
20: Jayaraman DK, Das JM. Dysarthria. In: StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing, 2025. PMID 37279355
21: Kent RD, Vorperian HK. Speech impairment in Down Syndrome: a review. J Speech Lang Hear Res 2013;56:178-210. PMID 23275397
22: Kotlarek KJ, Krueger BI. Treatment of speech sound errors in cleft palate: a tutorial for speech-language pathology assistants. Lang Speech Hear Serv Sch 2023;54(1):171-88. PMID 36599098
23: Kucuk Ceyhan A, Sennaroğlu G, Yucel, E, San, I. Phonological development of children with cochlear implants. Speech Lang Hear 2024;28(1):1-11.
24: Lai CSL, Fisher SE, Hurst JA, Vargha-Khadem F, Monaco AP. A forkhead-domain gene is mutated in a severe speech and language disorder. Nature 2001;413(6855):519-23. PMID 11586359
25: Lee AS, Gibbon FE. Non-speech oral motor treatment for children with developmental speech sound disorders. Cochrane Database Syst Rev 2015;(3):CD009383. PMID 25805060
26: Lewis BA, Freebairn LA, Hansen AJ, Miscimarra L, Iyengar SK, Taylor HG. Speech and language skills of parents of children with speech sound disorders. Am J Speech Lang Pathol 2007;16:108-18. PMID 17456889
27: Lewis BA, Freebairn L, Tag J, et al. Adolescent outcomes of children with early speech sound disorders with and without language impairment. Am J Speech Lang Pathol 2015;24(2):150-63. PMID 25569242
28: Lewis BA, Miller GJ, Iyengar SK, Stein C, Benchek P. Long-term outcomes for individuals with childhood apraxia of speech. J Speech Lang Hear Res 2024;67(9S):3463-3479. PMID 37734154
29: Lousada M, Jesus LM, Hall A, Joffe V. Intelligibility as a clinical outcome measure following intervention with children with phonologically based speech-sound disorders. Int J Lang Commun Disord 2014;49(5):584-601. PMID 24861159
30: Maas E. Treatment for childhood apraxia of speech: past, present, and future. J Speech Lang Hear Res 2024;67(9S):3495-520. PMID 38768073
31: McLeod S, Crowe K. Children's consonant acquisition in 27 languages: a cross-linguistic review. Am J Speech Lang Pathol 2018;27(4):1546-71.** PMID 30177993
32: Mei C, Reilly S, Bickerton M, et al. Speech in children with cerebral palsy. Dev Med Child Neurol 2020;62(12):1374-82. PMID 32588921
33: Morgan AT, Amor DJ, St John MD, Scheffer IE, Hildebrand MS. Genetic architecture of childhood speech disorder: a review. Mol Psychiatry 2024;29(5):1281-92. PMID 38366112
34: Morgan AT, Liegeois F, Kiederkere C, et al. Role of cerebellum in fine speech control in childhood: persistent dysarthria after surgical treatment for posterior fossa tumour. Brain Lang 2011;117:69-76. PMID 21334735
35: Morgan AT, Vogel AP. Intervention for dysarthria associated with acquired brain injury in children and adolescents (review). Cochrane Database Syst Rev 2008;(3):CD006279. PMID 18646143
36: Muttiah N, Georges K, Brachenbury T. Clinical and research perspectives on nonspeech oral motor treatments and evidence-based practice. Am J Speech Lang Pathol 2011;20:47-59. PMID 21173395
37: Nabila CNM, Putri FP, Iswinarti. Speech sound disorders in early childhood and their impact on pre-literacy and literacy skills: a systematic review. Journal of Scientific Research, Education, and Technology 2024;3(4):1743-55.
38: Pennington L, Dave M, Rudd J, Hidecker MJC, Caynes K, Pearce MS. Communication disorders in young children with cerebral palsy. Dev Med Child Neurol 2020;62(10):1161-9. PMID 32729634
39: Pennington L, Parker NK, Kelly H, Miller N. Speech therapy for children with dysarthria acquired before three years of age. Cochrane Database Syst Rev 2016;7:CD006937. PMID 27428115
40: Peter B, Davis J, Bruce L, et al. Toward preventing speech and language disorders of known genetic origin: first post-intervention results of Babble Boot Camp in children with classic galactosemia. Am J Speech Lang Pathol 2021;30(6):2616-34. PMID 34665663
41: Peter B, Finestack L, Loveall S, et al. Babble Boot Camp for infants with Down syndrome: piloting a proactive, caregiver-led intervention designed to boost earliest speech and language skills. Am J Speech Lang Pathol 2025;34(3):1041-57. PMID 40153250
42: Preston JL, Caballero NF, Leece MC, Wang D, Herbst BM, Benway NR. A randomized controlled trial of treatment distribution and biofeedback effects on speech production in school-age children with apraxia of speech. J Speech Lang Hear Res 2024;67(9S):3414-36. PMID 37611182
43: Preston JL, Hull M, Edwards ML. Preschool speech error patterns predict articulation and phonological awareness outcomes in children with histories of speech sound disorders. Am J Speech Lang Pathol 2013;22(2):173-84. PMID 23184137
44: Rezaei P, Poorjavad M, Abdali H. Speech outcomes after palatal closure in 3-7-year-old children. Braz J Otorhinolaryngol 2020:S1808-8694(20)30152-X. PMID 33268307
45: Salt H, Claessen M, Johnston T, Smart S. Speech production in young children with tongue-tie. Int J Pediatr Otorhinolaryngol 2020;134:110035. PMID 32298924
46: Scholderle T, Staiger A, Lampe R, Strecker K, Ziegler W. Dysarthria in adults with cerebral palsy: clinical presentation and impacts on communication. J Speech Lang Hear Res 2016;59(2):216-29. PMID 27057824
47: Selassie GR, Viggedal G, Olsson I, Jennische M. Speech, language, and cognition in preschool children with epilepsy. Dev Med Child Neurol 2008;50(6):432-8. PMID 18422681
48: Sellars C, Hughes T, Langhorne P. Speech and language therapy for dysarthria due to non-progressive brain damage. Cochrane Database Syst Rev 2002;(4):CD002088. PMID 12519567
49: Sices L, Taylor HG, Freebairn L, Hansen A, Lewis B. Relationship between speech-sound disorders and early literacy skills in preschool-age children: impact of comorbid language impairment. J Dev Behav Pediatr 2007;28(6):438-47. PMID 18091088
50: Stein CM, Millard C, Kluge A, et al. Speech sound disorder influenced by a locus in 15q14 region. Behav Genet 2006;36(6):858-68. PMID 16786424
51: Storkel HL. The complexity approach to phonological treatment: how to select treatment targets. Lang Speech Hear Svc 2018;49(3):463-81. PMID 29582052
52: Strom MA, Silverberg JI. Eczema is associated with childhood speech disorder: a retrospective analysis from the national survey of children’s health and the national health interview study. J Pediatr 2016;168:185-92. PMID 26520915
53: Turner SJ, Hildebrand MS, Block S, et al. Small intragenic deletion in FOXP2 associated with childhood apraxia of speech and dysarthria. Am J Med Genet A 2013;161A(9):2321-6. PMID 23918746
54: Tyler AA. What works: evidence-based intervention for children with speech sound disorders. Semin Speech Lang 2008;29(4):320-30. PMID 19058119
55: Velleman S. Childhood Apraxia of Speech Resource Guide. Clifton Park, NY: Delmar Learning, 2003.
56: Vellutino FR, Fletcher JM, Snowling MJ, Scanlon DM. Specific reading disability (dyslexia): what have we learned in the past four decades. J Child Psychol Psychiatry 2004;45(1):2-40. PMID 14959801
57: Webb AN, Hao W, Hong P. The effect of tongue-tie division on breastfeeding and speech articulation: a systematic review. Int J Pediatr Otorhinolaryngol 2013;77(5):635-46. PMID 23537928
58: Wren Y, Miller LL, Peters TJ, Emond A, Roulstone S. Prevalence and predictors of persistent speech sound disorder at eight years old: findings from a population cohort study. J Speech Lang Hear Res 2016;59(4):647-73. PMID 27367606
59: Yorkston KM, Beukelman DR, Duffy J, et al. Evidence-based practice guidelines for dysarthria: management of velopharyngeal function. J Med Speech Lang Pathol 2001;9(4):257-73.
60: Yorkston KM, Beukelman DR, Strand EA, Bell KR. Management of motor speech disorders in children and adults. 2nd edition. Austin, TX: Pro-Ed, 1999.

Contributors

All contributors' financial relationships have been reviewed and mitigated to ensure that this and every other article is free from commercial bias.

Author

Hope Dickinson MS CCC-SLP

Dr. Dickinson of Boston Children's Hospital has no relevant financial relationships to disclose.
See Profile

Editor

Alcy R Torres MD FAAP

Dr. Torres of Boston Medical Center and Boston University Chobanian and Avedisian School of Medicine has no relevant financial relationships to disclose.
See Profile

Former Authors

Jennifer Accardo MD
Vera Joanna Burton MD PhD
Justine Ker BA
Stephen L Nelson Jr MD PhD
Michael V Johnston MD†
Amanda Haverfield MCD CCC-SLP
Ann Tilton MD
Jennifer Accardo MD (original author), Vera Joanna Burton MD PhD, Justine Ker BA, Stephen L Nelson Jr MD PhD, and Amanda Haverfield MCD CCC-SLP

Patient Profile

Age range of presentation: 2 to 12 years
Sex preponderance: male > female, >2:1
Heredity: Heredity may be a factor
Population groups selectively affected: No population groups selectively affected
Occupation groups selectively affected: No occupational groups selectively affected

ICD & OMIM codes

ICD-10: Specific speech articulation disorder: F80.0

Other developmental disorders of speech and language: F80.8

Other and unspecified speech disturbances: R47.8
ICD-11: Developmental speech sound disorder: 6A01.0

Developmental speech fluency disorder: 6A01.1

Developmental language disorder: 6A01.2

Other specified developmental speech or language disorders: 6A01.Y

Developmental speech or language disorders, unspecified: 6A01.Z

Speech disturbances, unspecified: MA80.Z

This is an article preview.
Start a Free Account
to access the full version.

Nearly 3,000 illustrations, including video clips of neurologic disorders.
Every article is reviewed by our esteemed Editorial Board for accuracy and currency.
Full spectrum of neurology in 1,200 comprehensive articles.
Listen to MedLink on the go with Audio versions of each article.

Questions or Comment?

MedLink, LLC

3525 Del Mar Heights Rd, Ste 304
San Diego, CA 92130-2122

Toll Free (U.S. + Canada): 800-452-2400

US Number: +1-619-640-4660

Support: service@medlink.com

Editor: editor@medlink.com

ISSN: 2831-9125

Speech sound disorders

Associated Disorders

ADHD
Angelman syndrome
Arnold-Chiari malformations
Attention deficit hyperactivity disorder
Autism spectrum disorder
- Cerebral palsy
- Childhood apraxia of speech
- Cleft palate
- Developmental apraxia of speech
- Down syndrome
- Dysarthria
- Dyslexia
- Dysphagia
- Intellectual disability
- Language disorders
- Moebius syndrome
- Phonological disorders
- Prader-Willi syndrome
- Speech sound disorders

Differential Diagnosis

conductive and sensorineural hearing loss
atopy
allergic rhinitis
eczema
stuttering
- expressive language disorders
- Landau-Kleffner syndrome
- variations in pronunciation attributable to dialect
- learning English as a second language
- apraxia
- dysarthrias
- chemoradiation

Speech sound disorders

Cite this article

Introduction

Overview

Key points

Historical note and terminology

Clinical manifestations

Presentation and course

Prognosis and complications

Clinical vignette

Biological basis

Etiology and pathogenesis

Epidemiology

Prevention

Differential diagnosis

Table 1. Speech Milestones in Young Children

Confusing conditions

Diagnostic workup

Management

Outcomes

Special considerations

Anesthesia

References

Contributors

Author

Editor

Former Authors

Patient Profile

ICD & OMIM codes

This is an article preview. Start a Free Account to access the full version.

Questions or Comment?

Also in This Category

Ataxia-telangiectasia

Developmental delay in children: evaluation and management

Neonatal opioid withdrawal syndrome

Guillain-Barre syndrome in children

Mirdametinib

Nusinersen

Selumetinib

Epilepsy surgery in children

This is an article preview.
Start a Free Account
to access the full version.